Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Stein, Paul D.; Alpert, Joseph S.; Bussey, Henry I.; Dalen, James E.; Turpie, Alexander G.G.

doi:10.1378/chest.119.1_suppl.220s

Cited by 308 publications

(57 citation statements)

References 51 publications

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“…The decision whether to leave a patient with an indication for long-term anticoagulation on OAC or to exchange it for dual antiplatelet administration should be weighed against the risk of both thromboembolic and hemorrhagic complications. In the presence of mechanical prosthetic heart valve, the AR of thromboembolism has been reported at about 0.5–5% per year, depending on the valve type and generation, aortic and mitral position and age of patients, with no adequate protection provided by antiplatelet agents only [13]. For patients with venous thromboembolic disease, the early risk of recurrence is very high (up to 40% within the first month) [14], so that a course of 3–6 months of OAC is recommended after a first episode [15].…”

Section: Discussionmentioning

confidence: 99%

“…However, in this patient subgroup, antiplatelet treatment is acceptable in the absence of high or moderate risk features, such as previous stroke/transient ischemic attack or systemic embolism, hypertension, poor left ventricular function, age >65 years, rheumatic mitral valve disease, prosthetic heart valve, diabetes and coronary artery disease [15]. Relative to the safety profile of optimal chronic OAC, an average occurrence of major hemorrhages has been reported at 0.4–6.6% per year in patients with mechanical prosthetic heart valves [13], at about 5% in patients with venous thromboembolism [18]and at 0.4–4% in patients with atrial fibrillation [17]. Therefore, antithrombotic treatment with OAC and aspirin appears appropriate after PCI-S in patients with mechanical prosthetic heart valve, (recent) venous thromboembolic disease and high-risk permanent atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Trials Comparing Oral Anticoagulation and Aspirin versus Dual Antiplatelet Therapy after Coronary Stenting

et al. 2005

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The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative (RR) risk of cardiac events and hemorrhagic/vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25–0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06–1.14) and major bleeding (RR 0.36; 95% CI 0.14–1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65, 3.8, 4.2, 6.4 and 6.6%, respectively. In conclusion, due to the low AR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Trials Comparing Oral Anticoagulation and Aspirin versus Dual Antiplatelet Therapy after Coronary Stenting

et al. 2005

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“…zwischen einer effektiv interventionell behandelten Koronarstenose und einer diffusen unbehandelten Atherosklerose, unterschieden. Unstreitig ist der Einsatz der Antikoagulation bei Patienten mit Klappenerkankungen, also bei Mitralklappenstenose und nach Kunstklappenersatz [51].…”

Section: Risikostratifikation Für Thromboembolische Ereignisseunclassified

Prävention arterieller Thromboembolien bei Patienten mit Vorhofflimmern

Schuchert¹,

Meinertz²

2002

Herz

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Patients with a low risk need no anticoagulation or can take aspirin. Patients with a high risk should receive oral anticoagulation with an INR range from 2.0 to 3.0. Newer guidelines recommend also for patients with intermediate level of stroke risk instead of aspirin the prescription of oral anticoagulation. Patients with a medium risk can interrupt the oral anticoagulation before surgery or invasive diagnostic procedures for 1 week, patients with a high risk should receive heparin. 3-4 weeks before and after cardioversion the standard therapy is oral anticoagulation.

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“…However, both of them have limitations. Mechanical valves are characterized by high durability, however, the need for the long-term anticoagulation is their major limitation of this type of prosthesis [4,5,6]. Potential immunogenicity, a risk of calcification, are the major limitations of biological heart valves.…”

Section: Introductionmentioning

confidence: 99%

Biocompatibility Issue Of Tissue Engineered Heart Valves

Wilczek¹

2015

Archives of Metallurgy and Materials

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Tissue engineering is a new field of knowledge which creates the possibilities for producing bioactive cardiac prostheses that will characterize by biomechanical and morphological properties similar to native tissue. It is expected that it will be characterized by high durability, which is very important from the social and clinical point of view. The aim of the study was to compare the cytotoxic effect of enzymatic and detergent acellularization methods commonly used for the biological scaffold preparation. It seems that the use of enzymatic methods, allows efficient donor cells removal while maintaining the ability to autologous cell seeding. Heart valves bioprosthesis created using these techniques, may be a good alternative to the currently used prostheses.Keywords: tissue engineering, heart valve, cytotoxicity, scaffold.Inżynieria tkankowa jest nową dziedziną wiedzy, która stwarza możliwości wytwarzania protez serca bioaktywnych charakteryzujących się właściwościami biomechanicznymi i morfologicznymi zbliżonymi do tkanki rodzimej. Oczekuje się, że proteza serca będzie charakteryzować się wysoką trwałością, co jest bardzo ważne z punktu widzenia społecznego i klinicznego. Celem badania było porównanie efektu cytotoksycznego enzymatycznych i detergentowych metod usuwania komórek, powszechnie stosowanych do wytwarzania biologicznych rusztowań. Wydaje się, że stosowanie metod enzymatycznych, umożliwia wydajne usunięcie komórek dawcy przy zachowaniu zdolności do autologicznego posiewu komórek. Bioprotezy zastawek serca tworzone za pomocą tej techniki mogą być dobrą alternatywą dla obecnie stosowanych mechanicznych i biologicznych protez zastawek serca.

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Antithrombotic Therapy in Patients With Mechanical and Biological Prosthetic Heart Valves

Cited by 308 publications

References 51 publications

Meta-Analysis of Trials Comparing Oral Anticoagulation and Aspirin versus Dual Antiplatelet Therapy after Coronary Stenting

Meta-Analysis of Trials Comparing Oral Anticoagulation and Aspirin versus Dual Antiplatelet Therapy after Coronary Stenting

Prävention arterieller Thromboembolien bei Patienten mit Vorhofflimmern

Biocompatibility Issue Of Tissue Engineered Heart Valves

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